Being uninsured can't be that bad, right? In fact, President George W. Bush said, "People have access to health care in America. After all, you just go to an emergency room."

"Access" means that you can get to see a health care provider, and by law anyone who shows up in an emergency room (ER) must be seen - so the president technically was correct. In fact, one in every four uninsured people gets care in the ER. But ERs are surely not the best place to get preventive or ongoing care. About half of uninsured adults have a chronic disease like cancer, heart disease or diabetes. The lack of regular care for the uninsured is why they have death rates 25 percent higher than those with insurance; more than half of uninsured diabetics go without needed medical care; those with breast and colon cancer have a 35 percent to 50 percent higher chance of dying from their disease; and they are three times more likely to postpone needed care for pregnancy. Clearly, the uninsured don't get the care they need

What does this have to do with you - other than the fact that you better hope you keep your health insurance? The uninsured cost you money: Doctors provide more than $4.2 billion per year in care to the uninsured and you are subsidizing that. How about the next time you have a true emergency? Uninsured patients are three times more likely to use the ER for regular care, contributing to the fact that more than 500,000 ambulances in the U.S. (about one per minute) are turned away because the ER is full.

So let's agree that being uninsured is really bad for the uninsured and for the rest of us.

What does this have to do with Texas? Yet again, Texas ranks dead last (to turn a phrase) among states, with 27.2 percent, uninsured; undocumented immigrants are only about 20 percent of the problem. If you take them out, Texas would rank 45th. "Just get them to pony up, get a job and buy health insurance," you say? Fully 83 percent of the uninsured work, but Texas is close to the bottom with only 52.4 percent of workers receiving health insurance through their employers. Only 20 percent of the uninsured can afford health insurance; if you add up food, rent and transportation, there's not a lot left. You may think for those who cannot afford health insurance, there surely is Medicaid. Well, if you are a parent of a child and make more than $4,600 per year, you are not eligible for Medicaid; if you have no children, you are not eligible for Medicaid at all unless you are blind, disabled or have kidney disease.

What does this have to do with the U.S.? As the presidential contenders have to defend their records, Gov. Rick Perry and former Gov. Mitt Romney sit as bookends - Texas with the highest uninsured rate and Massachusetts with the lowest. If Perry's fix is giving the states a block grant for Medicaid, he will need to show how that will reduce the percent of uninsured four years later and what it would cost - around the time he would be coming up for re-election. The RAND Corp. has estimated that under the Affordable Care Act, 5 million more Texans would have health insurance coverage (2.7 million on Medicaid) at a cost to the state of $2.5 billion per year, which is about $500 per life. That's a pretty good deal.

But the answer to whether uninsured Texans get all the care they need in the emergency room is: False.